The reason the [Affordable Care Act] mandates that individuals buy health insurance is because Obama wants to reach near-universal health coverage via a private insurance system. The law bars insurers from denying coverage based on preexisting medical conditions -- a reform that Republicans, along with Democrats, say is essential. It's why Republicans who pledge to repeal Obamacare on the stump vow in the next breath to reenact this core provision.

But here's the rub: You can't force health plans to offer coverage to everyone, regardless of medical condition, if you don't make sure everyone is in the insurance pool. Without such a mandate, people have an incentive to wait until they get sick to buy coverage. Insurance can't work that way. The result is a classic insurance "death spiral" in which, on average, sicker people are in the pool, which makes premiums rise, which in turn forces healthier people out of coverage they can't afford, which then leaves the pool filled with even sicker people on average, which sends premiums higher again, and so on. This is why states that have forced insurers to accept all comers without also having a coverage mandate (such as New York and New Jersey) have seen rates soar and coverage shrink -- hardly what officials intended. This is Health Insurance 101. (The other piece is that you need subsidies for low-income folks if you're going to have the mandate, which is why Obamacare is expensive.)

Republicans used to understand these economics perfectly. That's why Bob Dole, Howard Baker, John Chaffee and Mitt Romney (among others) have all supported individual mandates. Are all these Republicans constitutional rogues? No one disputes that the federal government has the power to stop insurers from denying coverage based on preexisting conditions. Under the Constitution, the feds thus have the corresponding power to enact reasonable measures to assure that this reform actually works....

The irony is that conservatives, either from confusion or for the sheer fun of taking a political bite out of Democrats, are fighting the one measure that's essential if private insurance is to retain its central role in American health care....

So, conservatives, be careful what you wish for. By fighting the mandate needed to make private insurance solutions work and doing nothing to ease the health cost burden on everyday Americans, you'll hasten the day when the public throws up its hands and says, "Just give us single-payer and price controls." Don't think the anti-government wave this fall won't reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world's costliest, most inefficient care.

Matt, your column makes perfect sense. It's a sad sign of the bankruptcy of one of our major parties and our broken political discourse, that Republican lawmakers would fight what was once a pragmatic, centrist idea that had the support of prominent Republicans like Bob Dole and Howard Baker.

However it's futile to ask the nihilists and reactionaries who populate the Republican leadership today to look past the next election, and think about what might take the place of healthcare reform and the individual mandate.

After all, these are the same people who think nothing about demanding permanent tax cuts for the wealthiest Americans even when it's clear that these cuts have devastated the economy and have put the nation on a fast track to permanent second tier status in the world. These people are clearly in it only for their short term self interest.

I hope the courts will continue to rule against the mandate that everyone must buy insurance or pay a penalty. If this is ruled "consitutional" whats to stop government from telling us what we can eat and what we can drink? We will face the nanny state on steroids if Obamacare is ruled constitutional.

Miller offers up a totally false straw man arguement by stating that a Supreme Court rejection of the public mandate will usher in a single payer system. Such a system is not the answer as current events in Europe and elsewhere prove such systems pruduce mediocre results and a unsustainable price. We need to deconstruct our current third party payer system with its myriad and confusing rubric of federal and state regulations and replace with a creative and flexible new system. It can be done. The only truly free market we have for medical services is in the field of elective surgery (lasik and plastic) not covered by health insurance. The prices for these services are dropping as their availibility is increasing. Implement tort reform, allow people to buy insurance across state lines, increase the supply of doctors by fast tracking qualified foreign docters and gradually phase out tax deductibility of employer provided health insurance and we can begin to get control of escalating health care costs.

actually, when the SCOTUS strikes down "obamacare" as UN-Constitutional, i expect the court to prohibit any other interference in "healthcare", as an invasion of freedom & exceeding the authority of their charter by the administration/congress.

everyone should know that when over 70% of Americans do not want anything, it is likely the wrong idea & "a stupuid idea".

"linda": you should really look hard in the Constitution & find us any provsion that allows the government to force the taxpayers to have any sort of healthcare plan.

to "richard": the problem with your SILLY opinion/post (SILLINESS, FOOLishness & errant STUPIDITY is very typical of DIMocRATS/libs/fascists.) is that you are NOT required to:
1. buy car insurance,
2.buy a car
and/or
3.even drive a car
if you, as a free citizen, choose not to do so.

do you not understand that your analogy of federal mandates on health insurance to (state required) car insurance is both FALSE & STUPID
and/or
do you (and other DIMocRAT statists/fascists) hope that other Americans ARE that clue-LESS?

PLEASE support your fact-FREE opinion with an actual citation from the Constitution, that allows the federal government to FORCE anyone to buy ANYTHING, if you can find such a provision.
(i'll save you some time - it's NOT in The Constitution. in point of fact, the situation is quite the opposite.)

actually, the 10th Amendment to the BoR PROHIBITS such federal intrusions into state/local/individual freedom, unless the states have ceded those specific powers to the central government.
(NO state has ceded such power to the feds, as of today.)

to all: fear not, gentle readers, in November 2012, we TEA PARTIERS/GOP/conservative/independent voters will DUMP obama & a large group of DIMocRAT extremists/lunatics/fascists/IDIOTS out of power & then we can return our nation to small/sane/commonsense & CONSTITUTIONAL government.
further, if you wish to help us return our republic to FREEDOM, join your local TEA PARTY group.- you will be warmly welcomed!

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